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aPaulN COUNTY OF SAN JOAQUIN <br /> ? '•oma OFFICE OF EMERGENCY SERVICES <br /> r 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> crtik8as'�P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUINES NA ADDR SS(Facility Be'n nspected) <br /> ACCOUNT# START DATE(New Bus)IWJPFCKION DATE I ARRIVAL TIME IDEPARTURE TIME I-10 <br /> PECO N E <br /> 2 -ZqjAy <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate X 17. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> 1CKNOWL DGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business resentat ve(Pant ame and Title) Business Re ntative tgnature <br /> ^ WHITE COPY: OES <br /> /Ih PINK COPY: BUSINESS <br /> REV 1 <br />